If hip pain and pelvic floor symptoms appeared around the same time — or seem to worsen together — that is not a coincidence.
The pelvic floor and the hip muscles share the same structural neighborhood. They attach to the same bones, influence the same joints, and coordinate as part of the same pressure management system. When one is not functioning well the other compensates — and that compensation is what drives hip pain that doesn’t respond to standard stretching or strengthening.
Why Pelvic Floor and Hip Pain Are Connected
Your pelvis is the structural center of your body. Everything that attaches to it — your pelvic floor muscles below, your hip muscles around it, your deep abdominals in front, your spinal muscles behind — forms an integrated system that needs to coordinate for any single component to work properly.
The glutes and pelvic floor are functional neighbors. Your glute muscles attach directly to the pelvis and sacrum — the same structures your pelvic floor attaches to. Weak or underactive glutes place more demand on the pelvic floor during movement. An overloaded pelvic floor responds by increasing tension — and chronic pelvic floor tension affects how the hip joint moves and how the surrounding muscles function.
Pelvic floor tension creates referred pain patterns. A pelvic floor holding chronic tension does not just affect the pelvic area. Tension in the deep pelvic muscles can refer pain into the hip, groin, inner thigh and buttock — areas that feel genuinely painful but where the source of the problem is the pelvic floor rather than the hip itself. This is why hip pain that has no clear structural explanation — no arthritis, no injury — is worth considering from a pelvic floor perspective.
Poor coordination affects load distribution through the hip. When the pelvic floor, deep abdominals and glutes are not coordinating well together the hip joint absorbs uneven load during movement. Over time this creates wear patterns and strain that produce hip pain — particularly during activities like walking, climbing stairs and getting up from sitting.
Posture drives both simultaneously. An anterior pelvic tilt — where the pelvis tips forward — is one of the most common postural patterns after 40. It compresses the pelvic floor from above and places the hip flexors in a shortened position that contributes to hip pain. Addressing posture addresses both problems at the same time rather than treating them separately.
For more on how the whole core system connects read why your core feels weak even if you exercise.
Why This Gets More Common After 40
Several factors make the pelvic floor and hip pain connection more significant in midlife.
Estrogen decline affects connective tissue throughout the pelvis. Estrogen receptors are present in the pelvic floor, hip joint capsule and surrounding connective tissue. As estrogen declines during perimenopause and menopause this tissue loses elasticity and resilience — making the whole pelvic region more vulnerable to the coordination breakdowns that drive both pelvic floor symptoms and hip pain.
Decades of movement habits accumulate. How you walk, stand, sit and carry load over decades shapes the coordination patterns of your pelvic floor and hip muscles. Patterns that were compensating quietly for years often become symptomatic as estrogen declines and the tissue’s ability to absorb that compensation reduces.
Tension becomes more common. After 40 pelvic floor tension is at least as common as weakness — and a tense pelvic floor directly affects how the surrounding hip muscles function.
What Hip Pain Driven by Pelvic Floor Dysfunction Looks Like
Not all hip pain is pelvic floor related. But certain patterns suggest the pelvic floor is part of the picture:
Hip or groin pain that appeared alongside pelvic floor symptoms. If leaking, urgency or pelvic pressure appeared around the same time as hip pain — or if both worsened during perimenopause — a shared root cause is likely.
Hip pain with no clear structural explanation. If imaging has shown no significant arthritis, labral tear or other structural problem but hip pain persists — the pelvic floor and surrounding muscle coordination is worth evaluating.
Pain that worsens with prolonged sitting or standing. Accumulated postural load throughout the day affects both pelvic floor tension and hip muscle strain simultaneously. If hip pain reliably worsens as the day progresses this pattern is consistent with pelvic floor involvement.
Hip pain alongside lower back symptoms. The pelvic floor, lower back and hip share the same coordination system. When all three are symptomatic together the source is almost always the whole system rather than any single structure. For more on this read pelvic floor and lower back pain.
What Actually Helps
Addressing pelvic floor and hip pain together requires working on the whole coordination system rather than treating each in isolation.
Glute activation alongside pelvic floor work. The glutes and pelvic floor need to coordinate together. Approaches that incorporate glute strengthening as part of pelvic floor training address the functional relationship between the two rather than isolating each separately.
Breathing coordination as the foundation. How you breathe during movement affects pressure distribution through the pelvis and hip simultaneously. Learning to exhale during exertion manages intra-abdominal pressure in ways that reduce demand on both the pelvic floor and the hip muscles.
Posture and alignment work. Addressing the pelvic tilt and postural patterns that drive both hip and pelvic floor problems produces changes that neither hip exercises nor pelvic floor exercises alone can replicate.
Tension release before strengthening. If pelvic floor tension is contributing to hip pain adding more contraction work makes things worse. Understanding whether tension or weakness is the primary pattern changes the starting point significantly.
Progressive whole-body coordination. Building coordination through functional movements — standing, hinging, walking with awareness — trains the pelvic floor and hip muscles in the context where they actually need to work together.
A Structured Approach Worth Considering
If you are looking for a program that addresses pelvic floor support as a whole-body coordination issue — one that specifically includes glute integration, breathing mechanics and postural work alongside pelvic floor training — Pelvic Floor Strong is one I have come across that takes this kind of integrated approach and is designed specifically for women in midlife.
Ready to see a structured approach designed specifically for women? See it here →
When to See a Professional
Hip pain that is severe, worsening, or accompanied by changes in range of motion deserves evaluation by your physician or a musculoskeletal specialist before beginning any exercise program. A pelvic floor physical therapist can assess whether the pelvic floor is contributing to your hip pain and provide personalized guidance. Both evaluations are valuable and work well alongside each other.
Sources: Mayo Clinic — Pelvic Floor Dysfunction · NIH — Bladder Control Problems in Women · Cleveland Clinic — Pelvic Floor Dysfunction · ACOG — Pelvic Support Problems
Why Pelvic Floor Symptoms Come and Go After 40 — What’s Actually Driving the Pattern